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143 Cards in this Set
- Front
- Back
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what is the most common joint?
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diarthrosis(synovial): freely moving articulations, enclosed by a capsule of fibrous articular cartilage, ligaments, articular cartilage, synovial membrane and bursae
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Role of the bursae in a joint
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is a potential sac in the joint spaces between tendons, ligaments, and bones to promote ease of motion where friction would occur
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What is a synarthrosis joint/
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suture (cranium) no movement is permitted, or a synchondrosis between the epiphysis and diaphysis of long bones, temp joint where cartilage is later replaced by bone
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What is an ampiarthrosis joint?
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symphesis (pubis) slightly movable, connected by a fibrocartilage disk. syndesmosis (radio/ulnar) bones are connected by ligaments
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What are the 6 types of diarthrosis (synovial) joints?
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Ball and socket (hip), Hinge (elbow), Pivot (atlantoaxial), conndyloid (radius and carpals), saddle (thumb at carpal/metacarpal joint), gliding (inververtebral)
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What are the two types of motion at the TMJ and how are they demonstrated?
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Hinge, and gliding, hinge is opening, gliding is protrusion, retraction, and lateral movement
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What area of the spine has the most motion, and what specific areas of that area have which movements?
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Cervical. occiput and atlas has most flexion/extension (50%) of cervical spine, and atlas and Axis has most rotation of cervical spine(50%)
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What makes up the glenohumoral joint?
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the head of humorous, and the glenoid fossa of the scapula. the acromion, coracoid process, and associated ligaments form the arch surrounding and protecting the joint
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What muscles and their tendons make up the rotator cuff?
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supraspinatus, infraspinatus, teres minor, and subscapularis. these reinforce the glenohumoral joint
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the elbow joint consists of what?
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the radius, ulna, humerus, in a synovial cavity. also the olecranon bursae and associated ligaments
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What type of joint is the wrist, and what motion is permitted there?
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a condyloid joint, flexion and extension, as well as radial and ulnar movement (pronation/supination.
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What type of joint is the hip joint, and what makes it up
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Ball and socket joint: head of femur, acetabulum, and 3 strong ligaments, which stabilize the femur in the acetabulum in the joint capsule
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What is the knee joint, and what makes it up?
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is a hinge joint, premitting flexion and extension. made up of femur, tibia, patella. surrounded by a joint capsule. has ligaments that provide A/P stability (cruciate ligaments) lateral stability (LCL, MCL) and cartilage (menisci) that provide cushioning between the articulating surfaces. Also has bursa
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What makes up the ankle (tibiotalar) joint, hat kind of joint is it?
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is the articulation of the tibia, talus, and fibula. protected by medial and lateral ligaments. is a hinge joint. (dorsi/plantar flexion) also has another joint, talocalcaneal joint, and transverse tarsal that permit pronation and supination of joint
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Two methods long bones grow
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endochondral growth, is the cartilage model (grows at epiphysis), lengthens bones. Appositional growth, increases thickness
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What characteristic of kids bones and ligaments increases chance of fracture over sprain?
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ligaments are stronger than bone until adolescence, so fractures to joints and long bones are more common than sprains
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When is total number of skeletal muscle fibers developed?
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fetal life
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During what tanner stage does growth spurt cause decrease in strength in epiphysis and overall strength and flexibility, increasing potential for injuries?
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tanner stage 3
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At what age does the final epiphysis close, completing the lengthening of long bones? When does bone mass stop increasing?
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20 years old. bone density will continue to increase through appositional growth until 35
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Increasing levels of estrogen and relaxin cause softening of cartilage and elasticity of ligaments occur during what period of pregnancy?
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12 to 20 weeks. causes pain and waddling gait
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Shifting center of gravity due to enlarging uterus, and compensatory lordosis causes backpain in what % or pregnant women?
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40-50%
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What % of pregnant women get gastrocnemius, thigh, and gluteal cramps during 2nd half of pregnancy?
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25%
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With increasing age, which phase of bone remodeling dominates, causing osteoporosis, osteopenia, and shortened stature?
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bone resorption, by 80 years old, postmenopausal women can lose as much as 30% of bone mass
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Bones most susceptible to bone resorption
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weight bearing, vertebra, head of femur, and long bones.
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What are other musculoskeletal changes associated with aging?
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loss of subcutaneous fat, fibrosis of connective tissue, deterioration of articulating cartilage, greater chance of fracture of long bones
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Risk factors for sports injury
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poor physical condition, poor warm up, intensity of competition, collision, rapid growth, overuse
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Risk factors for osteoporosis
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white, asian, native america, northwest europe, blonde, red hair, freckles. light frame, gender, family history, nulliparous, menopause before 45, sedentary life, scoliosis, RA, low Vit D or Ca intake, excessive carbonated drinks, metabolic disorders, drugs that decrease bone density, poor teeth, smoking/heavy drinking
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Risk factors for osteoarthritis
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obesity, family history, hypermobility syndromes, age over 40, injury, high level of sports activities, occupation (overuse)
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What are we looking for overall in musculoskeletal inspection?
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ability to stand erect, symmetry, allignment of extremities, lordosis, kyphosis, scoliiosis, discoloration, # of skin folds, deformity, bony enlargement, allignment, contour, swelling
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What are we looking for in the muscles?
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hypertrophy, fasciculations, and spasms, without assymetry or atrophy
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What are we looking for when we palpate the musculoskeletal system?
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heat, tenderness, swelling, spasticity, fluctuation of a joint, effusion, crepitus, pain, and resistance to pressure
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Active ROM should surpass passive ROM by how much?
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5 degrees
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What could indicate an underlying problem with the joint, muscle group, or nerve supply
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pain, limited ROM, spasticity, instability, deformity, and contracture
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If there is an abnormal ROM, what tool can we use to measure the joint ROM?
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goniometer. start fully extended, then flex and measure the angle of greatest flexion/extension
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What are the muscle function levels? (strength)
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0: no evidence of movement, 1: trace of movement, 2: full ROM, not against gravity, 3: full ROM against gravity, not resistance, 4: full ROM against gravity and some resistance, 5: full ROM against gravity and full resistance
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To indicate full ROM of the TMJ, what should be the space when the upper and lower jaw are fully opened?
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3-6 cm between upper and lower teeth
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How far should the mandible move laterally?
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1-2 cm
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What is the normal degree of flexion, extension, sidebending, and rotation of the cervical spine?
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45 degrees flexion, 45 degrees extension, sidebending 40 degrees each way, rotation is 70 degrees each way
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What would you expect to see in the spine of a pregnant/obese patient, or a elderly patient?
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pregnant/obese patient: increased lordosis to shift center of gravity back over lower extremities. In elderly patient, increased kyphosis due to compression of anterior vertebra
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What is a gibbus, ad when is it seen?
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sharp angular deformity, seen in compression fractures in those with osteoporosis
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What is the normal number of vertebrae? which demographics have less, which have more?
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24 is normal(85%), 11% have 23, 5% have 25. women have 23 more than men. Native Americans have the 25 variant more
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A lateral curvature of the spine or a rib hump should cause you to suspect what?
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scoliosis
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What is the ROM of the thoracic spine? flexion/extension, sidebending, and rotation?
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flexion 75-90 ending is 35 degrees, hyperextension of 30 degrees. sidebending is 35 degrees bilaterally, rotation of upper trunk is 30 degrees each direction
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If one shoulder is asymmetric with a hollow in the rounding contour, what would you suspect?
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dislocation
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A winged scapula would indicate what
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bad serratus anterior usually from a damaged long thoracic nerve
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What is the ROM for the glenohumoral joint in flexion, extension, adduction, adduction, internal rotation, and external rotation?
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flexion 180, hyperextension 50 degrees, abduction 180, adduction 50, int rot 50, ext rot 50 degrees.
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Shrugging shoulders is a test of which cranial nerve?
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CN 11
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Subcutaneous nodules along pressure points of the ulnar surface could be indicative of?
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rheumatoid arthritis
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Normal carrying angle of arm. what is it if its less, what is it if its more?
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normal is 15 degrees, cubitus valgus if >15, and cubitus varus if <5 degrees
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A tender, boggy, swollen epicondyle, or increased pain with pronation or supination could indicate what?
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epicondylitis or tendonitis
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Ulnar deviation, subluxation of the MCP's, swan neck, and boutonniere deformities indicate what?
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RA
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2-3 mm hard, nontender, bony overgrowths in the DIP's are called what? what are they if the are in the PIP's? what disease are they associated with?
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in the DIP's they are haberden's nodes, in the PIP's they are bouchard's nodes, they indicate osteoarthritis.
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Painful fusiform swelling of the PIP's, causing spindle shaped fingers are associated with what
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the acute stage of RA
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Cystic, round, nontender swellings along tendon sheaths or joint capsules that are more prominent in flexion, indicate what?
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Ganglia. also found as a firm mass over the dorsum of the wrist
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What is ROM of the wrist/carpal joint in flexion/extension, and adduction/abduction, when the palm is flat on a surface?
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flexion is 90 degrees, hyperextension is 70 degrees, adduction(radial dev) is 20 degrees, and abduction(ulnar dev) is 55 degrees.
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What is the ROM of the MCP joint in flexion and extension?
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flexion is 90 degrees, and hyperextension is 30 degrees
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While supine, standing, or prone, and the leg is extended (straight) what is the ROM of flexion, extension, what is the ROM of flexion with the knee flexed?
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Flexion (straight legged) <90 degrees, extension is <30 degrees, with knee flexed, 120 degrees
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While supine what do you expect the internal and external rotation ROM to be of the hip?
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Internal rotation is 40 degrees, and external rotation is 45 degrees
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What is the normal angle between the femur and the tibia? what is it if its larger, what if its smaller/
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normal angle is <15 degrees, <5 degrees is 15 is knock kneed or genu valgum, and is >15 degrees (bowlegged) in genu varum
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What is the expected ROM of the Knee joint?
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Flexion 130 degrees, hyperextension 15 degrees
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What do calluses and corns on a foot indicate?
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chronic pressure or irritation
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The feet should be in line with the tibias, what are deviation from this norm called?
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in toed: pes varus, out toed: pes valgus
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The midline of the adult foot should pass from what to what
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the midline of the heel to between the 2nd and 3rd toes
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What is Pes Planus and Pez cavus?
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Pes planus is a foot that remains flat without weight bearing (flat foot) pes cavus is an instep that remains high even on weight bearing
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Pez cavus is often associated with what other deformity?
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claw toes
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hyperextension of the MTP joint, and along with flexion of the toes proximal joint is called what?
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hammer toe
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A flexion deformity of the DIP joint ot toe is called what?
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mallet toe
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A lateral deviation of the great toe, with or without overlapping of 2nd toe, sometimes causing bursa inflammation, known as a bunion is called what?
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hallux valgus
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Heat, redness, swelling, and tenderness are signs of an inflamed joint, could be cause by what?
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RA, septic joint, fracture, or tendonitis
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An inflamed MTP joint of the great toe lead you to suspect what?
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Gouty arthritis. a draining tophus may sometimes be present
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A thickened achilles tendon may indicate what?
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hyperlipidemia
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What is the ROM of the ankle joint in dorsiflexion, plantar flexion, inversin, eversion, abduction, and adduction?
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dorsiflexion 20, plantar flexion 45, inversion 30, eversion 20, abduction 10, and adduction 20 degrees
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Where is leg length measured? and how?
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from the ASIS to the medial malleolus, crossing the knee on the medial side
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Where is arm length measured, and how?
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from the acromion process to the distal ulnar prominence, through the olecranon process.
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What is the Neer test? and what is it used to determine?
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Internal rotation, while flexing to 150 degrees. presses on supraspinatus, tests for rotator cuff inflammation or tear
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What is the hawkins test? what does it identify?
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flex the shoulder and elbow to 90 degrees. Internally rotate the arm to its limit. Pain is associated with rotator cuff inflammation or tear
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Positive results on which 4 tests increase likelihood that the patient will have a + electrodiagnostic study for Carpel Tunnel Syndrome
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flick test, or classic/probable distriibution of symptoms on Katz hand diagram, hypalgesia, and weak thumb abduction.
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Which two tests are not as accurate for carpel tunnel syndrome diagnosis?
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Tinel and Phalen
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If when the patient is asked to demonstrate what causes them the worst hand pain, numbness, and tingling, and they demonstrate a flicking movement of wrist, this is a positive what?
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flick test
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What does the thumb abduction test isolate?
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the strength of the abductor pollicis brevis muscle. It is innervated only by the median nerve
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What is the Tinel sign?
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when you strike the patient's wrist where the median nerve passes under the flexor retinaculum, and it causes a flash of pain or tingling along median nerve distribution. positive for carpel tunnel
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What is the Phalen test?
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patients holds their two hands together in a fully palmar flexed position for 1 minute. numbness and paresthesia, indicate carpel tunnel
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The straight leg raise and Bragard stretch test, are used to determine impingement or disk herniation of which cranial nerve roots?
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L4, L5, and S1
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The Lase'gue sign is an indicator of what?
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tension on nerve roots L4, L5, and S1. It is pain with <30 degrees of straight leg flexion, flexion of the knee will often eliminate the pain. crossover pain is more supportive of tension on the nerve roots
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When the straight leg test is performed, on the ipsilateral and contralateral legs, what is its sensitivity and specificity for disk herniation?
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affected leg: 80% sensitive, 40% specific, on the contralateral leg: 25% sensitive, but 90% specific
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What is the femoral stretch test used to detect?
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Inflammation of the nerve root at L1, L2, L3, and sometimes L4. Patient lies prone and extends the hip, pain is associated with a positive test
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What is ballottement used for in a knee exam?
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To detect excess fluid or effusion of the knee, press down sharply on patella against femur, if effusion is present, tapping or clicking will be present. release patella while keeping 1 finger on, will feel floating in effusion
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What does the bulge sign assess?
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Excess fluid in knee. Milk the medial aspect of the knee upward 2 or three times, then tap the lateral aspect of patella. observe for a bulge of returning fluid
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What does the McMurray test identify?
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torn lateral or medial meniscus. For lateral use varus stress and int rot, for medial use valgus stress and ext rot
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What does the anterior and posterior drawer test indentify?
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a + anterior drawer test indicates a torn CL, a + posterior drawer test indicates a torn PCL. A + test is more than 5mm of movement in either direction
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What is the Lachman test used to identify?
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an ACL tear. test is + with greater than 5 mm of motion compared to unaffected side
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the varus and valgus stress test is used to identify what?
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varus (medial) force against ankle while holding knee immobile tests the LCL, valgus (lateral force) against ankle with knee immobilized tests the MCL
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What is the Apley test, and what does it test?
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patient is prone with knee flexed to 90 degrees. downward pressure with int/ext rotation. clicks, locking, or pain indicate a meniscal injury
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What would a uft of hair near the base of spine indicate?
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Spina bifida occulta
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A transillumination mass at base of spine would indicate what?
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meningocele or myelomeningocele
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Unequal limb length or circumference in the newborn could be associated with what?
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intraabdominal neoplasms
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Midline of newborns foot may bisect which toes due to their metatarsus adductus (forefoot adduction)?
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3rd and 4th
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A simean crease across palm of infant is associate with what?
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Downs Syndrome
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What is one of the most missed findings in the newborn?
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fractured clavicle
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What is the barlow ortlani Maneuver used to detect?
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easily dislocated hips in children. barlow dislocates the easily dislocated hip, and the ortlani puts it back. An audible click or pop in either is a + test
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What is the Allis sign and what does it test?
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infant is supine with knees flexed, with feet flat on table. If one knee is lower than the other it is a + test. tests for hip dislocation or short femur
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Up to what age do black babies reach developmental milestones first?
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3 years
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What does sitting in the W position indicate?
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Intoeing, associated with femoral anteversion
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By what age should metatarsus adductus resolve?
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3 years old
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What constitutes Genu Valgum in a toddler?
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If knees are together and there is a 2.5 cm space between medial malleoli, common in kids between 2 and 4 years old. if greater than 5cm, there is a problem
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What is genu Varum? when is it pathological?
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genu varum is a gap between knees of more than 2.5 cm when medial malleoli are together. normal in kids until 18 months. is bad if space is greater than 4 cm
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What is the Gower's sign?
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when a kid is weak and had to use his hands to press on his thighs to get up
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If a pregnant woman's disk space between L4 and L5 becomes fixed before the spine is fully extended, she is said to be?
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hyperextended, results in lower back pain, usually resolves in 6 months after delivery
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Why do some women get carpel tunnel during last trimester?
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due to associated fluid retention during pregnancy
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After what age, do women automatically need bone density scans to screen for osteoporosis?
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64. at that point, they already meet the 9 point minimum to get the scans
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At what weight do women automatically need bone density measurements for osteoporosis, even without other factors?
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under 60 KG
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How does the osteoporosis risk assessment instrument? work, what is it?
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it assigns a point system based on age, weight, and estrogen use. you add these up, and if the score is greater than nine, it indicates a need for bone density measurements
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What is a hereditary condition seen in individuals that are HLA-B27 +, that causes ossification of the intervertebral discs, and loss of spinal mobility? (Bamboo spine)
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ankylosing spondylitis
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What is a lumbosacral radiculopathy (herniated lumbar disk) where is it most common seen? Common age group affected?
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is a herniated vertebral disk that irritates the corresponding nerve root. causing muscle weakness, pain, and paresthesia, in the area of the dermatome. normally affects L4, L5, S1 nerve roots. 31 and 50 years
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What is lumbar stenosis?
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hypertrophy of the ligamentum flavum and facet joints, results in narrowing of spinal cord. causes pain with walking or standing, that starts in the but and radiates down leg. relieved by sitting
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What is syndrome caused by compression of the median nerve by thickening of its flexor tendon sheath?
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Carpel Tunnel Syndrome
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What is gout?
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a form or arthritis caused by a disorder of purine metabolism. usually affects great toe first. has monosodium urate crystals in joint, causes exquisite pain. Can have gouty tophus associated
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What is TMJ syndrome?
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painful jaw movement caused by congenital abnormalities, malocclusion, trauma, arthritis, and other joint disease.
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What is an infection in the bone, usually caused by S Aureus, that causes resorption of bone, causes fever, headache and nausea. Causes necrosis of bone
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osteomyelitis
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What is Bursitis?
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inflammation of bursa, resulting from constant friction. can cause the sac to fill with fluid, causes limited ROM, warmth at site, and pain with movement
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what is pagets disease? what causes it, and what can it cause?
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is a metabolic disorder normally seen in people older than 45, causes increased bone resorption and increased remodeling in a mosiac pattern. causes hypercalcemia,
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Condition associated with nonarticular, painful muscles. widespread pain and aching, usually at least 11 tender points
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fibromyalgia.
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What is osteoarthritis?
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the deterioration of the articular cartilage covering the ends of the bone in synovial joints, from inflammatory and non inflammatory causes. leads to swelling, osteophites, and effusion of the joint
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Chronic, systemic, inflammatory, progressive disorder that can occur between 3 and 80 years old. thought to be autoimmune in nature. symptoms include painful, stiff joints in morning, bone deformities, nodules, etc...
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Rheumatoid arthritis
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What is a stretching or tearing of connective ligaments and tendons in a joint, caused by motion outside normal range
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Sprain. presents with swelling, hemorrhage, and loss of function
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Dislocation
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complete separation of contact between two bones of a joint
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Fracture
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partial or complete break in the continuity of a bone resulting from trauma (direct, indirect, twisting, or crushing). muscle contractions and spasms lead to shortening of tissue around the bone
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What does the neurovascular assessment entail?
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color, temp, capillary refill time, swelling, sensation, and movement.
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What are the ottawa ankle rules?
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rules to identify patients needing an x ray series for an injured ankle. there must be pain in the malleolar zone and at least on of the following: bone tenderness along distal 6 cm of tibia or fibula, non weight bearing for 4 steps
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What are the absolute exclusion criteria for an x ray according to the ottawa ankle rules
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age younger than 18, intoxication, multiple distracting injuries, pregnancy, head injury, and neurologic deficit
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What is an inflammation of the synovium lined sheath around a tendon?
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tenosynovitis or tendonitis
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Microtrauma to the rotator cuff muscles or their tendons, most often associated with supraspinatus
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rotator cuff tear. symptoms, inability to flex or abduct shoulder, pain, crepidus, weakness
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Myelomeningocele, meningocele, and spina bifida
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failure of vertebral column to close during gestation. the spinal cord and meninges are protruding in the myelomeningocele, just the meninges is protruding in the meningocele, and just a tuft of hair shows in spina bifida. due to folate deficiency early in pregnancy
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Clubfoot, (talipes equinovarus)
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fixed congenital defect of the ankle and foot. inversion of foot and ankle and plantar flexion. toes lower than heel
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metatarsus adductus (metatarsus varus)
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most common foot defoormity in infants. medial deviation of the toes and forefoot results from angulation of the tarsometatarsal joint. caused by fetal positioning in uterus. usually resoves in 6 months, with less than 10% needing cast or surgery
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developmental dysplasia of hip
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condition present at birth where the femoral head has an inappropriate relationship with the acetabulum, causes dislocation and instability. females affected more than males
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Legg-Calve-Perthes disease
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avascular necrosis of the femoral head resulting from decreased blood supply. most common in boys between 3 and 11, has a limp, loss of int rot and abduction, decreased ROM, referred pain to medial thigh, knee, or groin. bilateral in 10%
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Osgood Schlatter disease
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is a traction apophysitis (inflammation of a bony outgrowth) on the anterior aspect of the tibial tubercle, in association with inflammation of the patellar tendon. causes pain, limp, and swelling. aggrivated by strenuous activity. usually in males
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Slipped Capital Femoral Epiphysis
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the capital femoral epiphysis slips over the head of the femur. presents with knee pain, antalgic limp, weakness, and reduced int hip rotation. the affected kid is obese, tall, and between ages of 8 and 16. 75% are unilateral, girls are younger than boys. L more than R side
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Muscular Dystrophy
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genetic disorder causing gradual degredation of the muscle fibers. causing pseudo hypertrophy of calf muscles (fatty deposits) follows anticipation, worse every generation. causes clumsiness, frequent falls, waddling gait, and positive gower sign
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Scoliosis
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structural" physical deformity with a concave curvature of the anterior vertebral bodies, conves posterior curves, and lateral rotation of the thoracic spine. >10 degrees, but as bad as 20 to 60 degrees. causes a rib hump and frank asymmetry on flexion. causes physiological alterations in spine, chest, and pelvis. Structural most commpnly affects girls, progresses during adolescence, idiopathic, has a lateral curve, no rotation, and no trunk asymmetry. usually associated with leg length discrepancy
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Radial Head subluxation (nursemaids elbow)
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dislocation caused by jerking the arm upward, while the elbow is extended. pulls apart the joint, tearing the margin of the annular ligament around the radial head, and allows the torn ligament to obstruct the joint
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Dupuytren Contracture
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affects palmar fascia of one or more fingers, and tends to be bilateral. appears to have a hereditary component, incidence is more frequent iwth age, alcoholic liver disease, and epilepsy
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